This paper will specifically consider one of the major findings of a wider study (previously reported in Roddis, Holloway, Bond and Galvin1), concerning how patients acquired knowledge and information about their condition before being formally diagnosed. The overall purpose of this research was to explore and explain how people make sense of long-term health conditions. Through the use of both purposive and theoretical sampling within a grounded theory design, experiences of individuals with thrombophilia and asthma were explored.

In the years following the abolition of the English National Board for Nursing, Midwifery and Health Visiting (ENB) in 2002, concerns were raised within the Critical Care nursing community about a lack of consistency in post-registration education programmes. In response to this the Critical Care Network National Nurse Leads (CC3N) formed a sub-group, the Critical Care Nurse Education Review Forum (CCNERF) to address these concerns. A review of UK course provision confirmed marked inconsistency in the length, content and associated academic award. The CCNERF commenced a two phase project, first developing national standards for critical care nurse education such as length of course and academic credit level; followed by the development of a national competency framework1, 2. Following significant review and revision, version two of the National Competency Framework for Registered Nurses in Adult Critical Care was published by CC3N in 20153. This paper introduces the National Competency Framework and provides an overview of its background, development and implementation. It then considers the future direction of UK post-registration Critical Care nurse education.

Acute renal failure after cardiac surgery is known to be associated with significant short-term morbidity and mortality. There have as yet been no major reports on long-term quality of life (QOL). This study assessed the impact of acute kidney injury (AKI) and renal replacement therapy (RRT) on long-term survival and QOL after cardiac surgery. The need for long-term RRT is also assessed.

Objective Conduct a deep exploration of the outcomes that matter to people with a diagnosis of schizophrenia and understand from their perspective how these outcomes can be achieved. Sample and Methods In-depth qualitative interviews were conducted with 22 people with a diagnosis of schizophrenia. Interviews were analysed using thematic frameworks, and a realist informed theories of change approach. Results Our study revealed the potential causal relationships between the context of a person's life, short-term goals and long-term outcomes. We provide a nuanced and detailed exploration of outcomes that matter for people with schizophrenia in relation to self-defined well-being. Achieving life milestones, feeling safe and outcomes related to improved physical health along with employment, a positive sense of self and psychosocial outcomes, were highly valued. For short- and long-term outcomes to be achieved, individuals required medication with minimal side-effects, cognitive behavioural therapy, family/social support and meaningful activities in their lives. Well-being was influenced by life context and short- and long-term outcomes, but in a circular nature also framed what short-term goals could be achieved. Conclusions Working with people with a diagnosis of schizophrenia to identify and achieve better outcomes will necessitate a person-centred approach. This will require an appreciation of the relationship between the statutory and non-statutory resources that are available and a consideration of an individual's current well-being status. This approach acknowledges personal strengths and encourages ownership of goals and supports self-management.

Purpose To elicit bereaved families' experiences of organ and tissue donation. A specific objective was to determine families' perceptions of how their experiences influenced donation decision-making. Methods Retrospective, qualitative interviews were undertaken with 43 participants of 31 donor families to generate rich, informative data. Participant recruitment was via 10 National Health Service Trusts, representative of five regional organ donation services in the UK. Twelve families agreed to DBD, 18 agreed to DCD, 1 unknown. Participants' responses were contextualised using a temporal framework of ‘The Past’, which represented families' prior knowledge, experience, attitudes, beliefs, and intentions toward organ donation; ‘The Present’, which incorporated the moment in time when families experienced the potential for donation; and ‘The Future’, which corresponded to expectations and outcomes arising from the donation decision. Results Temporally interwoven experiences appeared to influence families' decisions to donate the organs of their deceased relative for transplantation. Conclusions The influence of temporality on donation-decision making is worthy of consideration in the planning of future education, policy, practice, and research for improved rates of family consent to donation.

Background: Prostate cancer is a major cause of cancer death in Nigerian men. Attempts to reduce mortality from prostate cancer have focused mainly on early detection of the disease by the use of PSA testing. As a result of the increased incidence of prostate cancer in Nigeria despite the widespread availability of testing facilities, it became pertinent to understand the salient factors that prompt Nigerian men to go for prostate cancer testing. Objective: This study explores the factors that influence a group of Nigerian men’s decision to go for Prostate Specific Antigen (PSA) testing. Methods: Following ethical approval, semi structured interviews were conducted with a group of 10 men who had PSA test following consultation with their doctor with signs and symptoms at the University of Benin Teaching Hospital from July to August, 2010. Interview transcripts were analysed by employing steps proposed by Collaizi (1978). Results: Five themes were identified: the symptoms experienced, the influence of friends and relatives, older age associated with increased awareness, accessibility to testing services and the knowledge of the PSA test. Conclusion: The study revealed that there continues to be a considerable lack of awareness and knowledge about prostate cancer and screening.

This study aimed to estimate the optimal body size, limb segment length, and girth or breadth ratios of 100-m breaststroke performance in youth swimmers. In total, 59 swimmers [male: n = 39, age = 11.5 (1.3) y; female: n = 20, age = 12.0 (1.0) y] participated in this study. To identify size/shape characteristics associated with 100-m breaststroke swimming performance, we computed a multiplicative allometric log-linear regression model, which was refined using backward elimination. Results showed that the 100-m breaststroke performance revealed a significant negative association with fat mass and a significant positive association with the segment length ratio (arm ratio = hand length/forearm length) and limb girth ratio (girth ratio = forearm girth/wrist girth). In addition, leg length, biacromial breadth, and biiliocristal breadth revealed significant positive associations with the 100-m breaststroke performance. However, height and body mass did not contribute to the model, suggesting that the advantage of longer levers was limb-specific rather than a general whole-body advantage. In fact, it is only by adopting multiplicative allometric models that the previously mentioned ratios could have been derived. These results highlighted the importance of considering anthropometric characteristics of youth breaststroke swimmers for talent identification and/or athlete monitoring purposes. In addition, these findings may assist orienting swimmers to the appropriate stroke based on their anthropometric characteristics.

OBJECTIVE: To compare the anthropometric and lifestyle characteristics of active and inactive adolescents in Saudi Arabia and Britain. METHODS: A school-based cross-sectional study was conducted at four cities in Saudi Arabia (Riyadh and Al-Khobar; N = 1,648) and Britain (Birmingham and Coventry; N = 1,158). The participants (14- to 18-year-olds) were randomly selected using a multistage stratified cluster sampling. Measurements included anthropometric [BMI, Waist circumference (WC), Waist to height ratio], screen time, validated physical activity questionnaire and dietary habits. RESULTS: British males were lighter (P = 0.04, 64.4 vs. 68.2 kg), and had lower values for WC (P = 0.003, 77.1 vs. 78.7 cm) than Saudi males. Males (P = 0.0001) were significantly more active than females but the difference between inactive Saudi and British females was greater than that between inactive Saudi and British males. Being female was significantly (P < 0.001) associated with lower activity levels in both the Saudi and British adolescents. Having lower frequency of fruit intake was significantly (P < 0.001) associated with lower activity levels, whereas increased frequency of consumption of French fries/potato chips was significantly (P = 0.008) associated with increased activity levels in Saudi adolescents. Among British adolescents, lower frequency of breakfast was (P = 0.045) associated with lower activity levels, increased frequency of consumption of sweetened beverages was significantly (P = 0.005) associated with higher activity levels. Higher energy drinks intake frequency was significantly (P = 0.007) associated with higher activity levels. CONCLUSION: The present study identifies crosscultural differences and similarities in lifestyle habits in adolescents from Britain and Saudi Arabia. Activity status (active vs. inactive) appears to play an important role in other lifestyle related behaviors, with active adolescent more likely to engage in healthy dietary behavior than their inactive peers, irrespective of country of origin.

Fractal patterns offer one way to represent the rough complexity of the natural world. Whilst they dominate many of our visual experiences in nature, little large-scale perceptual research has been done to explore how we respond aesthetically to these patterns. Previous research (Taylor et al., 2011) suggests that the fractal patterns with mid-range fractal dimensions (FDs) have universal aesthetic appeal. Perceptual and aesthetic responses to visual complexity have been more varied with findings suggesting both linear (Forsythe et al., 2011) and curvilinear (Berlyne, 1970) relationships. Individual differences have been found to account for many of the differences we see in aesthetic responses but some, such as culture, have received little attention within the fractal and complexity research fields. This two-study article aims to test preference responses to FD and visual complexity, using a large cohort (N = 443) of participants from around the world to allow universality claims to be tested. It explores the extent to which age, culture and gender can predict our preferences for fractally complex patterns. Following exploratory analysis that found strong correlations between FD and visual complexity, a series of linear mixed-effect models were implemented to explore if each of the individual variables could predict preference. The first tested a linear complexity model (likelihood of selecting the more complex image from the pair of images) and the second a mid-range FD model (likelihood of selecting an image within mid-range). Results show that individual differences can reliably predict preferences for complexity across culture, gender and age. However, in fitting with current findings the mid-range models show greater consistency in preference not mediated by gender, age or culture. This article supports the established theory that the mid-range fractal patterns appear to be a universal construct underlying preference but also highlights the fragility of universal claims by demonstrating individual differences in preference for the interrelated concept of visual complexity. This highlights a current stalemate in the field of empirical aesthetics.

Objective: The notion that artistic capability increases with dementia is both novel and largely unsupported by available literature. Recent research has suggested an emergence of artistic capabilities to be a by-product of involuntary behaviour seen with dementia, as opposed to a progression in original thinking (de Souza, et al., 2010). A far more complementary explanation comes from Hannemann (2006), who suggests that art offers an outlet for dementia patients to refine and sharpen their cognitive abilities. As dementia severely impedes linguistic skills, non-verbal therapeutic methods such as painting can
permit dementia patients to express themselves in a way not possible verbally. Fractal analysis has been used to determine the authenticity of major works of art. Taylor et al., (1999) found that through a fractal analysis of Jackson Pollock’s paintings it was possible to distinguish authentic works from a large collection of fakes, demonstrating that when artists paint they instill within their work their own pattern of unique fractal behaviour. Can age-indexed variations in the fractal dimension of the works of artists anticipate specific cognitive deteriorations? Method: To answer this question we analysed age-related variations in the fractal dimension of a large corpus of digital images (n⫽2092) of work created by seven notable artists who experienced both normal ageing and neurodegenerative disorders.
Results: The results of our analysis showed that patterns of change in the fractal dimension of the paintings differentiated artists who suffered neurological deterioration from those of normal aging controls.
Conclusions: These findings are of importance for two reasons. Our work adds to studies that demonstrate that fractal analysis has the potential to determine the provenance of paintings. Secondly, our work suggests that may be possible to identify a-typical changes in the structure of an artist’s work; changes that may be early indicators of the onset of neurological deterioration.

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